Enriched Versus Standard NICU Environments and Preterm Brain Development: A Systematic Review of Structural,...

Preterm infants are at increased risk of developing abnormal brain structure. Research has also indicated that the environment of the NICU could affect the early development of the infant's nervous system. Methods used to evaluate brain development and white matter maturation include structural magnetic resonance imaging (MRI), diffusion tensor imaging, and selected functional MRI techniques. This qualitative systematic review without meta-analysis synthesized evidence from neuroimaging studies evaluating enriched versus standard NICU environments in preterm infants. A systematic literature search of PubMed and Scopus databases identified randomized controlled trials (RCTs) and prospective studies reporting neuroimaging outcomes. For RCTs, the risk of bias was assessed using the Cochrane Risk of Bias tool, and cohort studies were evaluated using the Newcastle-Ottawa scale. A quantitative meta-analysis was considered but was not feasible because of substantial heterogeneity in interventions, imaging modalities, outcome measures, regions of interest, follow-up duration, and reporting standards. Therefore, findings were synthesized qualitatively. Each included study evaluated one or more enriched NICU interventions, including Newborn Individualized Developmental Care and Assessment Program (NIDCAP)-based developmental care, single-family-room care, structured music interventions, parent-sensitivity interventions, and stress-reduction strategies. Several included studies reported that NIDCAP-based developmental care and structured music interventions were associated with favorable neurodevelopmental or neuroimaging findings, whereas evidence for single-family-room care was mixed. Separate observational studies found that greater procedural pain and NICU stress exposure were associated with less favorable neuroimaging outcomes. However, heterogeneity, small sample sizes, follow-up publications from some parent cohorts, and residual confounding limit causal inference and preclude firm clinical recommendations.